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Strong Beginnings

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According to Peggy Vander Meulen, Program Director at Strong Beginnings, looking at the infant mortality rate is like taking a snapshot to see the country's overall health and wellbeing. America ranks at no. 41 worldwide. And while that fact may be unsettling, what's even more disconcerting is the racial disparity that exists in this figure. If African American and Caucasian populations were separated into their own separate countries, the Caucasian country would rank somewhere near 25. The African American country, however, would rank 91. In 2003, Grand Rapids had the highest black infant mortality rate in Michigan at 22.4 deaths per 1000 live births -- by comparison, white mothers were three times more likely to have a successful pregnancy.

In 2000-2001, Vander Meulen was part of a group that came together to look at what could be done about this shocking disparity in birth outcomes. The group was fairly small in size -- 12 to 15 -- and came to be called The Infant Health Implementation Team. Meetings, community conversations, research analysis and local studies led them to identify three areas that would have the greatest impact when it came to improving maternal child heath. "Improving access to quality care, preventing unplanned pregnancy and dismantling racism," Vander Meulen lists. "We called that package of activities we came up with Strong Beginnings."

What started out as a small group with three broad goals came together with funding. "All the big health players came together -- Saint Mary's, Metro Health Department, Grand Rapids African American Health Institute (GRAAHI), Spectrum," she says. "It was agreed that Spectrum would be the fiduciary, and the other players would be all be partners in this program if it were funded." In 2003, the same year Grand Rapids held the highest infant mortality rate than any other city in Michigan, they submitted for Healthy Start funding. In 2004, they were funded. The local group of volunteers became a large program with 65 employees and 12 committees. Vander Meulen says the federal grant required them to work on two levels -- providing direct services, and working "at the systems level to improve the overall level of care." Conducting outreach, recruiting women, offering case management and finding community health workers (many of whom were former participants) to serve as a bridge between the community and the resources being offered are all part of Strong Beginning's work. "We work with women through pregnancy and then for two years after the baby is born," Vander Meulen says. "We also have a mental health program through Arbor Circle where we have two full-time therapists working to serve our highest risk women."

When it comes to improving birth outcomes, Vander Meulen says you can first look at individual behaviors. Smoking, substance abuse, depression, infections and stressors are all things that can cause premature birth. Other negative factors may include domestic violence, poor nutrition, exposure to toxins, poverty, homelessness, lack of insurance, lack of care of mistrust of health care providers. It's also important that mothers know that the ideal space between pregnancies is 18 months, and providing education and access to family planning is imperative as well. But these things, Vander Meulen says, do not account for the overwhelming disparity.

"There's some research going on 20 years old that shows, in a nutshell, that what accounts for disparities is the chronic stress of exposure to racism over a lifetime," Vander Meulen says. "It's not the stress of being pregnant, but that chronic stress over a lifetime. Being followed in a store, pulled over, called names… from the time that the woman is a child. There are generational impacts. A female in the womb is exposed to her mother's stress hormones. They measure this, and it shows up in higher blood pressures, weaker immune systems and the release of all sorts of stress hormones. And that results in lowered blood flow to the baby."

Vander Meulen says that white women who smoke have better outcomes than black women who do not. The same goes for white women in poverty versus black women with good incomes, white women who have never finished high school versus black women with graduate degrees and white women with no prenatal care versus black women with optimal prenatal care. And it's not biological. African woman in Africa have better outcomes than African American women here.

Strong Beginnings works to dismantle racism by "conducting levels of training on creating an inclusive healthcare environment," Vander Meulen says. Often, this involves training members of an organization who will then report back, as opposed to sending in an outsider to talk about a touchy subject with strangers.

Another tool for helping build awareness of racism and its negative effects comes from the play Lines: The Lived Experience of Race by Stephanie Sandberg, a professor of Theatre at Calvin College. Based on interviews conducted with 150 Grand Rapids residents about their experiences and views on racism, the play featured actors reciting interview answers verbatim. A video of the play is used to facilitate dialog concerning racism.

When the W.K. Kellogg Foundation awarded a grant to Strong Beginnings in April of 2011, they were able to expand their program capacity to more of Kent County, not just the city of Grand Rapids, as well as bring on Jonathan Bates as a Fatherhood Coordinator.

"We've always known that fathers are a critical piece of family life and of child well-being," Vander Meulen says.

Bates has a long and varied history in social work, most recently acting as a case manager for Project Rehab. He's been a foster care case worker, a supervisor at a secure residential treatment facility for adult males and a case manager for the Department of Human Services. No stranger to facilitating groups for men working through various issues, Bates was a perfect fit for the job. Additionally, Bates has five children of his own.

"I wear a lot of different hats [here]," he says. "I facilitate groups with the men in our program, I do some community education. I go out to the community agencies and look at how father-friendly they are. A lot of people really don't engage dads, and a lot of times, dads feel that when they walk into a doctor's office."

Bates has also been doing a lot of training in the last few months he's been with Strong Beginnings, including curriculum training for 24/7 Dad. He mentions a recent example he heard in training where the facilitator asked participants to imagine looking at a playground and realizing one in every three children does not have a father at home. If you're looking at a playground of African American children, make that every two out of three.

"A lot of situations when mom and dad don't get along, one of the first things to happen is that the kid pays," Bates says. "It's important that you're involved in your kids' life even if you're not with the mom. A lack of involvement can really have a profound effect on the child being successful and able to deal with stress and life challenges. We talk about having positive communication. Even if you're not with the mom, when they're pregnant, all of the stress and problems are going to effect the child. So, we teach ways of conflict resolution and how to be able to co-exist and understand the whole pregnancy process, and we explain to mom how important it is for dad to be involved. It's not just about you -- it should be what's in the best interest for the child."

Bates also talks about reaching out to fathers who may be suffering from depression or other personal issues and helping them find ways to be healthy. Bates also talks about partnering with LINC to conduct a legal aid clinic to help fathers understand their obligations and rights in parenting. Bates also helps to plan future father/child activities. "Parenting," Bates stresses, "is a two-person job."

Vander Meulen perhaps sums things up best by admitting that "maternal child health and infant mortality is such a complex issue, and there's no easy solution. It's going to take the efforts of an entire community to really make a dent. We've made great progress, but we still have a long way to go. It's taken generations to get where we are today. We need to be able to continue to work to eliminate all racial disparity."

For more information on Strong Beginnings, you can visit them online here.